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Penny Pines Donation & Reporting Form

The following form is to accompany your check to the Forest Service and to

report donations to the CGCI Penny Pines Chairman

DO NOT MAIL CHECKS TO THE CGCI CHAIRMAN - ALL CHECKS ARE PAYABLE TO AND MAILED TO THE FOREST SERVICE OFFICE SELECTED

Donor *

Individual, Club or District making the donation

Club Name (if donor is an individual)

District (if donor is a club)

Forest receiving donation *

The forest service office where check is to be sent. Click on the office of choice.

Donation in honor of

More than one name can be listed on one form. Include full name of all individuals or groups being honored. Separate names with semi-colon.

Donation in memory of

More than one name can be listed on one form. Include full name of all individuals being memorialized. Separate names with semi-colon.

Total number of donations/plantations submitted on this form *

This is the TOTAL NUMBER of all plantations included in this donation (general, in honor and/or in memory)

Total dollar amount enclosed *$

Total dollar amount covering all donations listed on this form (1 = $68, 2 = $136 etc.). Checks should be $68 or multiples thereof.

Penny Pines certificate is to be mailed to *

In order for the US Forest Service to provide certificates: Please include the complete mailing address (Name, Street or PO Box, City and Zip Code) where certificate(s) should be sent. Note: If you are honoring/remembering more than one individual, and would like certificates for each individual or family, suggest all certificates be sent to one address (individual, club or district) for distribution.

Your name *

Individual submitting this form

Your email address *

Email address where we may reach you in the event there are questions.

Print TWO copies before clicking on the Submit button

Instructions

NOTE: If you are NOT a CGCI-affiliated club or district or a member of one, please do not submit this form.

Complete the form

Print TWO copies (one to mail with check, one for your files)

Click "Submit" to automatically send the form electronically to the CGCI Chairman.

Mail check and form to the US Forest Service selected

Checks are payable to the Forest Service USDA NOT to CGCI

One donation/plantation = $68; All checks should be $68 or multiples of $68